Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Department of Surgery, Tamil Nadu Dr. MGR Medical University, Chennai, India.
Surg Endosc. 2017 Dec;31(12):5209-5218. doi: 10.1007/s00464-017-5589-7. Epub 2017 May 19.
Several classification systems for assessing the surgical difficulty of laparoscopic liver resection (LLR) have been proposed. We evaluated three current classification systems, including traditional Major/Minor Classification, Complexity Classification, and the Difficulty Scoring System for predicting the surgical outcomes after LLR.
We reviewed the clinical data of 301 patients who underwent LLR for hepatocellular carcinoma between March 1, 2004 and June 30, 2015. We compared the intraoperative, pathologic, and postoperative outcomes according to the three classifications. We also compared the prognostic value of the three classifications using receiver operating characteristic (ROC) curves.
The Major/Minor Classification, Complexity Classification, and the Difficulty Scoring System efficiently differentiated surgical difficulty in terms of blood loss (P = 0.001, P = 0.009, and P < 0.001, respectively) and operation time (all P < 0.001). Regarding intraoperative outcomes, the Difficulty Scoring System and Complexity Classification successfully differentiated the transfusion rate (P = 0.001 and P < 0.001, respectively). However, only the Complexity Classification adequately predicted severe postoperative complications (P = 0.032), the severity of complications (P < 0.001), and the length of hospital stay (P = 0.005). In ROC curve analysis, the Complexity Classification (area under the curve [AUC] = 0.611) outperformed the Major/Minor Classification (AUC = 0.544) and the Difficulty Scoring System (AUC = 0.530) for predicting severe postoperative complications. None of the classification systems predicted recurrence or patient survival.
The Complexity Classification was superior to the other methods for assessing surgical difficulty and predicting complications after LLR for hepatocellular carcinoma.
已经提出了几种用于评估腹腔镜肝切除术 (LLR) 手术难度的分类系统。我们评估了三种当前的分类系统，包括传统的 Major/Minor 分类、复杂性分类和难度评分系统，用于预测 LLR 后的手术结果。
我们回顾了 2004 年 3 月 1 日至 2015 年 6 月 30 日期间接受 LLR 治疗肝细胞癌的 301 例患者的临床数据。我们根据三种分类方法比较了术中、病理和术后结果。我们还使用接收者操作特征 (ROC) 曲线比较了三种分类方法的预后价值。
Major/Minor 分类、复杂性分类和难度评分系统在出血量 (P=0.001、P=0.009 和 P<0.001，分别)和手术时间 (均 P<0.001)方面有效地区分了手术难度。就术中结果而言，难度评分系统和复杂性分类成功区分了输血率 (P=0.001 和 P<0.001，分别)。然而，只有复杂性分类充分预测了严重的术后并发症 (P=0.032)、并发症的严重程度 (P<0.001) 和住院时间 (P=0.005)。在 ROC 曲线分析中，复杂性分类 (曲线下面积 [AUC] = 0.611) 优于 Major/Minor 分类 (AUC = 0.544) 和难度评分系统 (AUC = 0.530)，用于预测严重的术后并发症。没有一种分类系统可以预测复发或患者生存。
复杂性分类在评估 LLR 治疗肝细胞癌的手术难度和预测并发症方面优于其他方法。
